Provider Demographics
NPI:1982499539
Name:ELLENHORN LLC
Entity type:Organization
Organization Name:ELLENHORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHYPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-956-7276
Mailing Address - Street 1:8737 VENICE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3258
Mailing Address - Country:US
Mailing Address - Phone:310-454-7901
Mailing Address - Fax:
Practice Address - Street 1:8737 VENICE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3258
Practice Address - Country:US
Practice Address - Phone:310-454-7901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty